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General NPI Number Information
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NPI Number | 1205377173
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Entity Type | Organization
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Legal Business Name | PREMIER COMPOUNDING PHARMACY, INC.
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2000 PGA BLVD. SUITE 5507
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408
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Country | US
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Telephone | 888-507-8621
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 PGA BLVD. SUITE 5507
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408
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Country | US
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Telephone | 888-507-8621
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO/OWNER
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Name | TRACY CHRISTIAN
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Credential | RPH, OWNER
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Telephone | 888-507-8621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH23481
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License Number State | FL
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